1. Field of the Invention
This invention relates to surgical devices and methods. More particularly, this invention relates to devices and methods for holding a blood vessel. While not limited thereto, the invention has particular application to the suturing of a blood vessel during endoscopic surgery.
2. State of the Art
When suturing a blood vessel, such as when performing an anastomosis (connection between two blood vessels), it is necessary to hold the end of the blood vessel such that the suture needle can be inserted at the proper location.
In a typical coronary artery bypass (CABG) surgical procedure, a blood vessel is grafted from another part of the body and it is connected to the blocked coronary artery past the blockage. In this case, one end of the grafted vessel is attached with sutures to the side of the coronary artery. In open-chest CABG procedures this is accomplished by having an assistant hold the open end of the grafted vessel with tweezers while the operator (surgeon) passes the needle through the edge of the vessel.
A typical anastomosis requires about twelve sutures equally spaced apart to make a secure connection. When performing this procedure endoscopically or with very small incisions (to minimize trauma to the patient), it is very difficult to hold the grafted vessel with tweezers for suturing because of space limitations. The difficulties are accentuated by the natural properties of the grafted vessels. The grafted vessel is very supple, slippery and irregular on the outside. It stretches considerably, moving out of the way when the operator tries to push the needle through it. Additionally, the operator must be careful not to damage or disrupt the inside of the grafted vessel wall (intima) as this can lead to circulation problems, including complete blockage.
The grafted vessel is usually either a vein taken out of the leg, or an artery taken from inside the chest wall. The arteries used from the chest wall are the internal mammary arteries (IMA). Most commonly the Left Internal mammary (LIMA) is used since most bypasses are done on the left side of the heart. Using an internal mammary artery has the advantage of only requiring one anastomosis: from the transected end of the graft to the side of the coronary artery. The other end of the internal mammery artery remains connected at its native juncture.
Thus, there remains a need in the art for an improved device (and corresponding method of operation) that holds a vessel in a fixed position and is suitable for use in space-constrained environments such as during suturing of a vessel graft in an endoscopic procedure.